Provider Demographics
NPI:1699389924
Name:FENSTERMACHER, KIRA (SPEECH LANGUAGE PAT)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:FENSTERMACHER
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PAT
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:
Other - Last Name:HOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPEECH LANGUAGE PAT
Mailing Address - Street 1:516 COOPER AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237
Mailing Address - Country:US
Mailing Address - Phone:701-352-2574
Mailing Address - Fax:701-352-0188
Practice Address - Street 1:501 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EMERADO
Practice Address - State:ND
Practice Address - Zip Code:58228
Practice Address - Country:US
Practice Address - Phone:701-594-5125
Practice Address - Fax:701-594-8180
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1867OtherSPEECH LICENSE NUMBER